Clinical Comparison of Mini-Percutaneous Nephrolithotomy with Vacuum Cleaner Effect or with a Vacuum-Assisted Access Sheath: A Single-Center Experience

Abstract

Purpose: To compare outcomes of two different miniaturized percutaneous nephrolithotomy (PCNL) techniques: minimally invasive PCNL (MIP) with the vacuum cleaner effect and vacuum-assisted mini-PCNL (vmPCNL). Materials and Methods: Data from 104 (66.7%) patients who underwent vmPCNL and 52 (33.3%) patients who underwent MIP at a single tertiary referral academic center between January 2016 and December 2019 were analyzed. Patient demographics and peri-and postoperative data were recorded, and propensity score matching was performed. Descriptive statistics and linear regression models were used to identify variables associated with operative time (OT) and patient effective dose. Logistic regression analyses were used to identify factors associated with infectious complications and stone-free (SF) status. Results: Patient demographics and stone characteristics were comparable between groups. vmPCNL was associated with shorter OT ( p < 0.001), fluoroscopy time, and patient effective dose (4.2 mSv vs 7.9 mSv; p < 0.001). A higher rate of infectious complications was found in the MIP group (25.0% vs 7.7%, p < 0.01). Linear regression analysis showed that stone volume, multiple stones, and MIP procedure (all p values £0.02) were associated with longer OT. Similarly, OT and the MIP procedure ( p £ 0.02) were associated with higher patient effective dose. Logistic regression analysis revealed that the stone volume, positive preoperative bladder urine culture, and MIP procedure (all p values £0.02) were associated with postoperative infectious complications. vmPCNL was not associated with the SF rate. Conclusions: Mini-PCNL performed with continuous active suction is associated with lower rates of infectious complications, shorter OT, and lower patient effective dose than MIP.

Cost analysis between mini-percutaneous nephrolithotomy with and without vacuum-assisted access sheath

“…High stone free rates, low complication rates, fast stone disintegration and shorter OT were all important characteristics of suction PCNL procedure [ 22 ]. vmPCNL, in particular, was associated with shorter OT, lower rates of infectious complications and lower need for additional equipment than classic mini-PCNL [ 14 ]. However, there is a lack of reports that specifically investigated costs associated with suction assisted PCNL in the real-life setting.…”

“…All procedures were performed by two experienced (> 150 PCNL performed) endourologists (E.M; F.L.) and the surgical technique was standardized for both surgeons [ 14 ].…”

“…Among the new instruments, the vacuum-assisted mini PCNL (vmPCNL) is a safe and effective treatment option for kidney stones [ 12 , 13 ]. Previous Authors have shown that vmPCNL was associated with shorter OT, reduced use of accessory devices for stone removal and lower intra-pelvic pressures than mini-PCNL, thanks to its continuous aspiration system that allows for simultaneous lithotripsy and litholapaxy [ 13 , 14 ]. Consequently, the rate of infectious complications was lower for vmPCNL than classic PCNL [ 13 , 14 ].…”

“…Previous Authors have shown that vmPCNL was associated with shorter OT, reduced use of accessory devices for stone removal and lower intra-pelvic pressures than mini-PCNL, thanks to its continuous aspiration system that allows for simultaneous lithotripsy and litholapaxy [ 13 , 14 ]. Consequently, the rate of infectious complications was lower for vmPCNL than classic PCNL [ 13 , 14 ]. Nonetheless, one of the major drawbacks of this system is its disposability, which may limit its use in the everyday clinical practice due to the fear of increasing the procedure-related costs.…”

Comparison of vacuum-assisted sheaths and normal sheaths in minimally invasive percutaneous nephrolithotomy: a systematic review and meta-analysis

“…Vacuum aspiration can be regulated manually or mechanically to keep the collecting system under negative pressure. Additionally, the nephroscope moves in and out conveniently through the movable sealing lid while preventing extremely high or low pressure [ 22 ]. To evaluate the effect and efficacy of the vacuum-assisted sheath, this meta-analysis was performed.…”